Provider Demographics
NPI:1366650202
Name:TOWN OF SOUTHPORT
Entity Type:Organization
Organization Name:TOWN OF SOUTHPORT
Other - Org Name:SOUTHPORT SCHOOL DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-633-2874
Mailing Address - Street 1:51 EMERY LN
Mailing Address - Street 2:
Mailing Address - City:BOOTHBAY HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04538-1964
Mailing Address - Country:US
Mailing Address - Phone:207-633-2874
Mailing Address - Fax:207-633-5458
Practice Address - Street 1:51 EMERY LN
Practice Address - Street 2:
Practice Address - City:BOOTHBAY HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04538-1964
Practice Address - Country:US
Practice Address - Phone:207-633-2874
Practice Address - Fax:207-633-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)